The Diabetes Magazine

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and has continued to write essays and fiction while raising her three sons (and many pets). Read full bio

“Now seems like a great time to explore the emotional side of living with, or caring for someone with, diabetes. What things can make dealing with diabetes an emotional issue for you and / or your loved one, and how do you cope?” Diabetes Blog Week

How many times a day do I do something really stupid, like eat? Look at any ordinary day of my life and you’ll realize that even though EVERY time I eat I’m distressed, I still keep doing it. All the time!

It goes something like this… how many carbs are in it? If I don’t bolus and just take a walk after, will that do the trick? What if I end up with really high blood sugar? Is this really worth a bolus? Will it satisfy me or will I be hungry again in an hour? What if I don’t eat now and try to wait until dinner? Then will I be so hungry that I’ll overeat at dinner? I remember reading somewhere that even too much lettuce can cause a BG spike, though I doubt it’s a very impressive one. Overeating is still definitely a bad idea. Wine always causes a sharp BG drop for me. So maybe I’ll just eat and drink more. But too much wine will make me drunk and hurt my liver. But not enough food will make me hungry and tired. But high blood sugar will wreck havoc on all of my organs…

Food, in any form (even lettuce!) is an emotional issue. It’s always against me. If I were the star of my own action movie, I wouldn’t be battling aliens or sharks. It would be me against a scoop of chocolate chip cookie dough ice cream the size of the moon.

But then – all jokes aside – not so long ago, I got my revenge on carbs, and for a flash in time it was blissful (and delicious).

Here’s how:

For the most part, I’m a good sleeper and I’m happy to go to bed early, take a nap whenever, and sleep in. But one night I had insomnia. And not being able to sleep when I want to probably aggravates me more than not being able to eat what I want to. Also insomnia makes me anxious, and anxiety raises BG. The more I thought about it, the more doomed I felt. But at some point during the restlessness, in a revelatory moment that I didn’t realize was idiotic until the morning, I figured out how could get my sleep and have my carbs, too. I would eat my way to sleep. I would use my diabetes as a cure for insomnia.

There was a fresh challah in the kitchen: thick, braided white bread with sugar. It’s one of my favorite things to eat, and it makes my blood sugar spike faster than the speed of light. A couple of bites of challah could take me to 250 in no time. And nothing makes me sleepier than high BG, especially when it comes on fast.

I hurried out to the kitchen, reached into the brown paper bag and grabbed the challah. I was going to eat white bread and it was going to be good for me. Because it would put me right to sleep. And I really needed to sleep. Because my BG is worse when I’m tired anyway. So this was really the most sensible thing to do. Plus, I would be using carbs to my advantage. Sweet and twisted (like a challah) revenge.

As expected, the challah did the trick. I was drowsy in no time and within a half hour I went from wide-awake to can’t-keep-my-eyes-open. And I wasn’t concerned in the least while the high BG did its thing corroding my insides, because it was a cure for insomnia. And as I drifted into a hyperglycemic slumber I had the satisfying thought that diabetes might be fucking me over in every way, but for one stupid night, I [seemingly] used it to my advantage.

“Let’s kick off Diabetes Blog Week by talking about the diabetes causes and issues that really get us fired up.”

Before my husband, Mike, was diagnosed with diabetes, he was – to my mind – a certified tough guy. He’d been a paratrooper, had a black belt in some kind of kickboxing/karate thing that I (clearly) know nothing about, and he ran long distances. Whenever I was with him, I felt safe and protected, kind of like having a husband and a Rottweiler all rolled into one. (The previous sentence is intended as a compliment.) And if you’d asked me to come up with a thousand adjectives to describe Mike, “weak” would not have made the list.

But then one day he got sick. We’d been in Atlanta with our baby for Mike’s cousin’s wedding, and had to cancel our flight home because Mike said he was too sick to fly. I had never heard Mike say there was something he couldn’t do. In fact, just a year earlier we’d been in Paris together and the night before our flight home, Mike got food poisoning from a dish of raw sea slugs. (There must be a sexy way to say sea slugs in French.) We had just a few hours between the dinner and our flight home, and Mike felt stomach cramps so severe, he was doubled over in pain. I suggested we stay an extra night in Paris until he felt better. He would hear nothing of it. When it was time to go, he pulled himself together, carried all the luggage, and off we went. He was not about to have his butt kicked by slimy sea slugs, and though he felt utterly horrid on the inside, you couldn’t tell on the outside.

So when Mike said he was too sick to fly home after his cousin’s wedding, you can probably imagine how shocking his statement was, especially since no one could see his sickness. He didn’t have a fever and though he did look pale, he seemed mostly okay, except for the hours he spent in bed curled up like a little pillbug.

We got home a few days later, and everything went back to normal. Mike was just really thirsty. Normal, but thirsty. But, you know, we lived in a hot climate and he ran a lot outside. It was definitely normal for him to be thirsty. Then he got even thirstier and wanted to drink things other than water – things that we rarely had in the house, like a gallon of orange juice (every day). And he wanted to have milkshakes for dinner. It was noticeably odd, but Mike was still running long distances. He had a great appetite. No signs of anything scary. That’s why we didn’t worry when he started to lose weight.

Months passed and slowly but surely Mike’s fluid intake increased as his weight decreased. But he still had a marvellous appetite and exercised like a champ. He peed like a champ, too. If you’re drinking a lot, though, you’re going to pee a lot. You don’t need to be a doctor to figure that much out. There was no reason for us to be alarmed. And Mike was out the door every morning at 6:30 to go to work. Sure, he felt tired, but so would anyone who worked a long, full day and was up half the night drinking and peeing and the other half because our baby was crying. Neither of us could ever catch up on sleep. We walked around like zombies, just trying to get through the day.

After about six months, Mike couldn’t feel his toes. He’d been out in the cold in wet boots, so there was a reasonable explanation, but still he was worried enough to talk to the doctor. Mike neglected to mention to the doctor that he was also drinking five gallons of liquid a day and peeing waterfalls. And the doctor didn’t think much of his numb toes. So Mike went on as usual, he kept drinking, eating, and losing weight. But he wasn’t running anymore. He could barely get out of bed. And his vision was blurry.

When we found out Mike had Type 1 diabetes, he was pretty close to dead. If we’d known even one thing about Type 1 diabetes, we might have had a clue. Mike could have gotten a blood test two weeks into his symptoms and he would have gotten insulin and been fine. He didn’t have to be within days, hours, minutes of falling into a coma.

When we talk about the importance of diabetes education, we’re generally referring to education for the people already living with it. I’d like diabetes education to include “real” awareness – not a campaign or public service announcement that no one who doesn’t have diabetes is going to notice, not just a campaign whose aim is to make life better for those already living with diabetes.

What if the symptoms of Type 1 were common knowledge? What if every school teacher in the country received information about Type 1 diabetes? In my middle school health class we learned about CPR and the Heimlich maneuvre. We learned not to eat fat or have sex before marriage, but we didn’t learn anything about diabetes. When my oldest son was born I received information about the vaccinations he would need, and all sorts of other stuff designed to educate overwhelm and terrify new parents. Nowhere did I read that if your child is extremely thirsty you should be concerned about Type 1 diabetes. But maybe if I had, something would have clicked when Mike was thirsty.

Mike’s terrifying diagnosis story is not unique. I’ve heard versions of it over and over again in both adults and children. Type 1 diabetes may not be preventable, but getting really sick because its undiagnosed definitely is. And along with the education of diabetes symptoms should come another very important message: Just because you have diabetes doesn’t mean you’re not a tough guy anymore. Mike and all of his post-diabetes accomplishments are proof that diabetes makes you stronger.

That awkward moment when someone asks a (seemingly) innocent question about your diabetes and all you can do is shrug, because if you open your mouth obscenities will fly out of it…

Okay, I’ll admit it: I’m on edge. The last few days have been rough on my family. My youngest son, Adam, became quite sick on Tuesday. And on Thursday night, things took a turn for the worse. On both Friday and Saturday, Mike and I took Adam to urgent care. Luckily, he was treated there and we did not have to go to the hospital. Unluckily, the treatment involved big injections into his butt. Adam was brave, but it was a painful ordeal. For him, though, it came and went. He mentioned a few times that his butt was sore, otherwise, he’s mostly himself again. For me, seeing him so sick ripped up my heart.

Adam had improved enough by Saturday night that Mike felt it was fine to go out with his running buddies to celebrate completing the Tiberias Marathon. I stayed home, and got the kids to bed. I could have easily gone to sleep at the same time as the kids, but I knew I should stay awake to catch up on the laundry and email I’d neglected for several days. It turns out to have been an excellent decision. Here’s why:

1. I had turned the ringer off on my phone when I was getting the kids to bed, and forgot to put it back on.

2. Mike forgot to take his keys when he went out.

3. On his way home from dinner, Mike started to feel really bad: disoriented and shaky.

4. In the elevator in our building, he texted to me, “please open.”

5. My phone didn’t make a sound, so I didn’t know to run to the door. But I was working at my computer, near the front door so I heard the scuffle of Mike’s arrival.

6. Mike was pale. “I think I’m low,” he said.

7. Yes, 35 is definitely low.

8. Mike ate voraciously. Anything his hand could reach went into his mouth. Then he collapsed on the couch and the roller coaster began.

I went back and forth between checking Adam and checking Mike for the next several hours. When all seemed okay, I allowed myself to fall asleep for a few hours. You might expect that I will now tell you how fragile everything felt over the weekend. It did. It was miserable. I’m so grateful that things are better right now. But, no, I’m not going that route. Instead, I’m going to talk about how pissed off I got when I relayed the story of the “35” to some friends. They all responded in the exact same way, by asking the innocent questions – what happened? or how did that happen?

You know what guys, hypoglycemia happens.

Hypoglycemia is part of life with diabetes. When you ask why it happened, the answers we can give you are that we took too much insulin or didn’t eat enough. We don’t really know how all of the other factors, like the ebb and flow of hormones, play in. But that doesn’t mean we’ve done something wrong, and those innocent questions of how and why leave us no choice but to answer that we’ve fucked up. So, yes, that’s the truth. But imagine if someone told you that you had to drive across the country without a map and predetermine the precise amount of gas it would take to do so, not to the gallon, but to the drop. There’s a good chance you’d run out of fuel on the way because you got lost and drove extra miles, and there’s a good chance you’d overestimate your needs, assuming traffic and detours, and have some to spare.

Next time I mention hypoglycemia, if I don’t offer up a reason, don’t ask me what happened. Just agree with me that it sucks. Blaming the unpredictability of diabetes is much kinder than blaming the person with diabetes.

Happy Diabetes Awareness Month! Mike and I had the wonderful opportunity to partner with Novo Nordisk to create a video about diabetes. I’m very grateful to Novo Nordisk for playing along with my silly side and to Catherine Price for her stellar interviews (and for wearing those pants in public).

Also check out videos by our friends Kerri Sparling and Manny Hernandez!

I’m a little late in learning about the cronut craze, but now that I know about cronuts, I hate diabetes a little more than usual.

If you haven’t been following, in May the Dominique Ansel Bakery in NYC created a pastry that is part croissant and part doughnut. The Cronut. The bakery produces 200 cronuts a day, and sells out immediately. Fans line up as much as two hours before opening in order to get a cronut. There is even a cronut blackmarket. Yep, cronut scalpers.

In this day and age of obesity and epidemic levels of diabetes, we should all be cringing about the fact that there’s a new carb on the block and it’s considerably more popular than spinach. And this carb is not just on the block anymore. Dunkin Donuts has launched its own version of the cronut in South Korea .

Cronuts – From Dunkin’ Donuts’s Photos on FaceBook

But, I’m having a hard time getting upset about the cronut. It sounds like the most delicious combination of carbs and I can’t help but admire the genius of Dominique Ansel. Out of curiosity, I visited Ansel’s website and checked out his online store (boutique, I mean). There’s a special joke in there for people with diabetes – a baked good aptly named DKA. There’s even an Extra Large DKA in case you want to die twice. The cronut, thankfully, lacks the initials that spell out death to diabetics. I might be reading too much into the cronut craze, but its popularity seems to represent a sort of rebellion, a broccoli backlash. After years of being bombarded with top ten lists exalting kale, the stress of the NYC soda ban, and those preachy Meatless Mondays folks, someone has finally given us what we want: really sweet carbs.

Though I haven’t tasted a cronut, I’m guessing it’s the best new carb since Cinnamon Toast Crunch cereal. What I’m saying is, although I’m against the cronut in principle, if you offered me one I wouldn’t say no thanks. I’d smile and bolus.

“I want the Chomps,” Mike said, but he was still struggling to open the bag.

“Want me to open it for you?”

“No,” Mike said.

“Are you sure?”

“Yes.”

I didn’t want to be annoying, but I offered my glucose tablets to Mike again. He refused them.

“Can I get you something else? Food?”

“No,” Mike said. Then he got the Chomps bag open and chewed four little candies.

I should know by now not to listen to the “no’s” of hypoglycemia. I should not try to be respectful of Mike’s pride. I should have stuck a glucose tablet in his mouth and told him to chew. I should have grabbed the Chomps bag and opened it for him.

“You okay?” I asked Mike. I wanted to hear a “yes” and go back to sleep.

“Yes.”

Just as I drifted back into sleep, I heard the thumps of heavy, clumsy footsteps on the steep stairway. Mike was stumbling to the kitchen for food. His way down was dangerous and something I could have prevented if I’d been more aggressive about treating his hypoglycemia.

The line between helping and offending is so fine. There is no set number to go by. Sometimes a 45 comes up in no time. Other times a 70 drops to 50 even after the glucose tablet. And it’s always so much worse at night, trying to snap out of dreams and into the unpredictable reality of hypoglycemia.

Just before I turned 14, in the middle of my eighth grade school year, my father, brother, and I left Houston and moved to NYC. We moved into a sublet on 108th Street and Riverside Drive. In contrast to sunny Houston, NYC was gray. Our building was dreary, and the wind off the river was so bitter it stung my face. But that was all tolerable because it was above ground. The most shocking hardship I faced in NYC was the subway ride to my school, Friends Seminary, on East 16th Street. The underground world was different – especially when we changed trains in Times Square. The stench of urine was so overpowering I had to hold my breath. And there was no escape from the devotees of L. Ron Hubbard, and their aggressive attempts to sell me copies of Dianetics.

Every ride to and from school felt like the journey in The Way Back. The one respite after a crowded subway ride home from school with my face stuck in the armpits of the passengers around me was a little shop called Happy Donuts down the street from my building. After we exited the subway station, my brother and I made a daily stop at Happy Donuts, and carried our treats home in a little white paper bag so we could eat them while we played Nintendo. (Looking back with the eyes of a mother, I can’t imagine allowing my sons to eat donuts every day nor can I imagine letting them eat them on the couch while playing a video game: crumbs and sticky fingers! My father, though, never told us not to buy donuts. I suppose he was just relieved we made it home. And, hey, the donuts were Happy and I wasn’t. Maybe he thought some of the donuts’ joy would rub off on me.)

The point of this story, I suppose, is to tell you that I am a big fan of donuts. But I have diabetes, so I don’t eat them. Now, I’d like to ask you to refrain from telling me that people with diabetes can eat anything they want. Sure, we can. But the consequences of donut-eating in a diabetic are harsh. It’s an almost guaranteed blood sugar disaster. Everyone with diabetes knows how difficult it is to bolus for a combination of sugar, wheat flour, and fat. But apparently the organizations and companies that represent people with diabetes and produce products for us, haven’t yet wrapped their brains around a very simple concept: junk food screws us over. Every. Single. Time.

I’m really not the type to throw out conspiracy theories. Really not. But when I attended a Dexcom party in Chicago a few days ago (which I was told by unofficial sources was a fundraiser for the American Diabetes Association (ADA)) and saw the biggest donut spread in the history of the world, my first thought was: Are they fucking kidding me? My second thought was: these guys are making sure they profit off our diabetes. How many blood glucose test strips will I use while I try to cover my donut? How badly will I wish I had a continuous glucose monitor while I’m pricking my finger every ten minutes to see the donut damage?

I wish I’d taken a picture of the make-your-own-donut spread. There was a long, long table with naked glazed donuts and beside them all sorts of add-ons, like chocolate syrup, sprinkles, etc. It was tortuous to be so close to those drool-worthy donuts. But never mind that it was insensitive to put a donut spread in front of diabetics. Where are your PR people, Dexcom? All you smart people taking care of diabetics – don’t you realize that serving donuts at a party to raise money for the American Diabetes Association – or any other diabetes-related organization – is like having a smoking party to raise money for lung cancer patients? It’s begging for ridicule. You’re giving the Onion free headlines.

So, at the party I had a little chat with an ADA person. “What’s with the donuts?” I asked. He shrugged, looked a bit embarrassed and told me it was an “after party” and “ a dessert party.”

Quick facts for the party planners: Diabetes doesn’t go away after dinner. And while the ADA suggests 45-60 grams of carb per meal is about right for most people (I disagree), a donut with toppings would likely run somewhere between 50-80 grams of carb.

But what’s really at stake here is not one party, one carb count, or one day of highs and lows, but rather, it’s the message you’re sending. In a country with soaring levels of diabetes and obesity, when you serve donuts, you’re saying, “We don’t care.” When you set piles of donuts out to tempt those of us who can’t secrete insulin, you’re not cool, you’re cruel.

You can’t work in diabetes and ignore the food issue. It’s true that having diabetes doesn’t mean you can’t have dessert. But dessert can be dark chocolate covered almonds, small truffles, cherries, berries with cream, bite-sized sweets. There are many options that aren’t over-the-top. And it’s also okay to tell people – loudly and clearly – that one of the best ways to keep blood glucose levels in range is to avoid eating things like donuts. In fact, I’d argue that it’s part of your job.

Unfortunately, I missed a few days of Diabetes Blog Week. But I really loved participating. I especially loved discovering new diabetes blogs and catching up on blogs I haven’t visited in a while. What struck me as I went through the blogs was how many amazing people there are in our diabetes community – so many kind and sensitive D-people. And they’re good writers, too! I really thank Karen Graffeo for organizing Diabetes Blog Week. It’s great to take a time out and focus on our community.

Today’s prompt:

As another Diabetes Blog Week draws to a close, let’s reflect on some of the great bloggers we’ve found this week. Give some love to three blog posts you’ve read and loved during Diabetes Blog Week, and tell us why they’re worth reading. Or share three blogs you’ve found this week that are new to you. (Thanks to Pearlsa of A Girl’s Reflections for inspiring this topic.)

1. I loved a post called Seasons of Love by Melissa Lee. Check out the video of her beautiful singing.

A study that might answer some questions about diabetes and marijuana appeared online this week in the American Journal of Medicine: The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults. The study is the first to investigate the relationship between marijuana use and fasting insulin, glucose, and insulin resistance.

Cannabis as illustrated in Köhler’s Medicinal Plants book from 1897

The American Journal of Medicine’s blog reports, “Participants who reported using marijuana in the past month had lower levels of fasting insulin and HOMA-IR [insulin resistance] and higher levels of high-density lipoprotein cholesterol (HDL-C). These associations were weaker among those who reported using marijuana at least once, but not in the past thirty days, suggesting that the impact of marijuana use on insulin and insulin resistance exists during periods of recent use. Current users had 16% lower fasting insulin levels than participants who reported never having used marijuana in their lifetimes.

Large waist circumference is linked to diabetes risk. In the current study there were also significant associations between marijuana use and smaller waist circumferences.”

The blog also quotes an author of the study, Elizabeth Penner, MD, MPH, who said that after subjects with a diagnosis of diabetes were excluded, the associations between marijuana use and insulin levels, HOMA-IR, waist circumference, and HDL-C were similar and remained statistically significant.

In summary, the study concludes three things about marijuana use: It was associated with lower levels of fasting insulin and insulin resistance, and smaller waist circumference. So marijuana users could have better blood sugar levels.

Does this study mean marijuana is safe for people with diabetes? No. This study is not a green light to pass the dutchie. There’s not enough evidence here to conclude that marijuana and diabetes are a good combination. But the study is significant because it’s a first, and it suggests that more research is needed to explore future treatments using the marijuana plant’s compound active ingredient, tetrahydrocannabinol, or THC.